Abstract 16167: Does Timing of Coronary Artery Bypass Surgery After ST-Elevation Myocardial Infarction Impact Early and Mid-Term Survival?
Objective: The optimal time-period for performing coronary artery bypass graft surgery (CABG) in patients with ST-elevation myocardial infarction (STEMI) is still not well established. Our study aimed to determine the effect of time-interval between onset of STEMI and CABG on 30-day mortality and mid-term survival.
Patients and methods: Between January 2007 and December 2012, 231 patients underwent CABG within 21 days after STEMI at our institution. Of these, 40 patients were in cardiogenic shock (CS). The patients were divided into three groups according to the time-interval between onset of STEMI and CABG: Group A: <14 hours (43 patients), Group B: 14-72 hours (101 patients), and Group C: >72 hours-21 days (87 patients). Predictors of 30-day and mid-term mortality were identified by logistic and Cox regression analyses, respectively.
Results: Overall 30-day mortality was 16.9%, but decreased to 10.5% when patients with CS were excluded. Thirty-day mortality of all patients in groups A, B, and C was 11.6%, 23.8%, and 11.5% (p=0.05), respectively. After excluding patients with CS, corresponding 30-day mortality was 3%, 14.3%, and 9.9% (p=0.2). Diabetes (odds ratio [OR]:3.5; p=0.004) and preoperative use of inotropes (OR:3.9; p=0.02) independently predicted 30-day mortality, but operative timing did not.
Three-year survival was 82.7±6% for Group A patients, 57.4±5% for Group B, and 68.1±1% for Group C [log rank 0.008]. Exclusion of CS patients resulted in better 3-year survival for all groups, but Group B continued to have the worst survival (92.8±4%, 65.1±6%, and 80.1±5% for groups A, B, and C, respectively, [log rank:0.04]). Diabetes (OR:2.2; p=0.003), preoperative dialysis (OR:2.9; p=0.02), emergent surgery (OR:3.8; p<0.0001) and CS (OR:4.0; p<0.0001) were associated with an increased risk of mid-term mortality, but, CABG performed within 14 hours of STEMI was protective against it (OR:0.3; p=0.006).
Conclusions: CABG performed within the first 14 hours after STEMI is associated with an acceptable early mortality and good mid-term survival. Hence, when indicated, surgery should be performed as early as possible in such patients. If delay is inevitable, surgery should be deferred for at least 72 hours post-STEMI in hemodynamically stable patients.
- © 2013 by American Heart Association, Inc.